Provider Demographics
NPI:1114997335
Name:THUROW, JEANINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:THUROW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9183 BLUE SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-8801
Mailing Address - Country:US
Mailing Address - Phone:608-516-0568
Mailing Address - Fax:
Practice Address - Street 1:W9183 BLUE SPRUCE LN
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-8801
Practice Address - Country:US
Practice Address - Phone:608-516-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI503-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60571OtherDEAN HEALTH INSURANCE
WI42940900Medicaid
WI60571OtherDEAN HEALTH INSURANCE
S21532Medicare UPIN
WIP100324061Medicare PIN